Latest Comments by CherylRNBSN - page 3

CherylRNBSN 6,565 Views

Joined: Mar 30, '12; Posts: 183 (56% Liked) ; Likes: 348

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  • 0

    Quote from needshaldol
    Please help me figure this out. What antibiotic is run at 12.5 ml/hr? I have been doing this job for tons of years and have never seen this. I have never run anything at 12.5 ml/hr. Yes, we will titrate morphine drips for example but antibiotics? If it is 50ml of zozyn it is run in 30 minutes. If 100ml of Zozyn, it is run in one hour. Unless it is a specific special antibiotic which the pharmacist will decide upon rate, or if it is some special circumstance, then please tell me what is run at that odd rate?
    Our institution has recently implemented this protocol, as it "works better"; rec'd note from pharmacy about mainainting blood levels...can't recall specifics, but it a more effective way to fight infection. But if you have a pt w fluid needs, you would need to pump Zosyn in to primary fluid line and maintain primary fluid infusion. It's different from a 30-60 min. infusion of antibiotic.

  • 1
    martinalpn likes this.

    Quote from annmariern
    And this is why a Nurses union is a godsend; they just wouldn't be able to get away with this. When understaffed we can submit an assisgnment against objection form basically stating that should any issues occur, complaints, falls, missed meds and all of the OP issues, you have great backup when they pull this crap.
    Annmariern, I have posted asking questions about unions and gotten little response. Where do you practice? My employer specifically states they are "non-union". I WANT TO LOOK INTO CHANGING THIS.

    I had a fall, which is a "nursing quality indicator." I say it is a staffing quality indicator! I was on three halls (pts all very far apart, and me running all different directions), with HIGH ACUITY pts. My manager recognized the acuity of my pts., so nothing much came of it. Which is my point. The fall would never have happened had staffing levels been adequate. Why are we held to impossible standards?

    I would like to PM you. I would like to learn more about unionizing..

  • 6
    AheleneRN, martinalpn, joanna73, and 3 others like this.

    Quote from OnlybyHisgraceRN
    My name is OnlybyhisgraceRN and I am a job hopper. Sigh. I started working at the age of 14 years old, I've had probably 20 different jobs over the past 10 years. My job history goes as follows:

    Age 14- Mcdonald's for a year or so. I gained weight off of big macs, fries, and shakes. So I decided to quit.

    Age 15- I worked as a dietary aide in a small community hospital. I left after a year for very stupid reasons.

    Age 16- A shoe store. I quit a year later.

    Age 17- I worked four different jobs. I worked at best buy for 3 months but was fired for letting a friend use my family discount. Then, I worked at marshalls for 3 weeks and quit due it being super chaotic and dealing with crazy customers. Next, I worked at michaels for 2 days... I honestly don't remember why I quit that job. My fourth job was as a student aid, I quit after 3 months because I became a CNA and wanted to work as such.

    Age-18 I worked as a school health aide, and lasted 2.5 years. I loved the job so much that I planned on staying as a nurse. However, everyone stated" No, go get your clinical experience". And so I did. After I received my LPN license I left the school system. In addition to the school job I worked for 2 nursing agencies as a float CNA/Sitter.

    Age-20 I worked as a LPN in an ALF. After a year I left, it was a new day on hell every single day.

    Age-21 I worked in a LTC, which I loved. I left after a year due to schedule conflict with school and they did not allow PRN.

    Age 22- I worked in subacute/LTC facility, another ALF, methadone clinic. The subacute and ALF were hell holes. I loved the Methadone clinic but I was PRN and they never had any hours. I also worked for 2 peds HH agency. I hated it because I felt like an over paid babysitter. My last job for this year was a PRN school nurse job for an agency that I'm currently employed.

    Age-23- I worked at a subacute facilty , I quit after three months when I received my RN license to pursue the "almighty" hospital experience. I then got hired into a CVICU. I lasted 7 months there( that is a thread all by itself, literally).

    Now I'm 24 years old and I find myself starting another job next week. All I can say is that I'm tired of job hopping. My long term goal is to find my home in nursing and stay there until I retire. Why is that so hard for me to do??? I feel so pathetic.

    Hopefully this year will be different, and I'll find my self at the same place by the end of the year.

    Child, really? (I say this with love, as someone old enough to be your mother.)

    When I read your post, my only thought was "What a go-getter!"

    You have worked CONSISTENTLY from a very young age. I only hope my own children are as hard working! I live to instill that kind of work ethic in them !

    You have a long work record, and have pursued education along the way. YOU ARE VERY YOUNG. No shame in your game. Work + education + self evaluation = success.

    Don't worry, you are doing a fine "job" of finding your path! :-) How much have you learned from all that?

    The PATH is not always so evident, take it from me. But keep looking, it is there. It twists, it turns, and sometimes it is darn right indiscernible, but keep looking...


  • 2
    redhead_NURSE98! and OCNRN63 like this.

    Quote from BlueDevil,DNP
    I think every nurse needs to put themselves into this scenario and have an idea about what they would do before it happens. I won't tell you you were wrong, because the "right" answer is going to vary for every person. However, I would have made them fire me, complete with thorough documentation of the events, including my rebuttal response.
    Here is what I like about BlueDevil's response: making them fire you, complete with a rebuttal response.

    It is SO EASY to "blame and shame" the nurse who is actually trying to do the work! I find that my charge nurses cannot staff for acuity; they staff by a formula...which is a formula for disaster sometimes!

    If you are toileting six pts. and having to handle pts vomiting and incontinent, pushing narcotics like mad, something has to give! Who do you attend to first? The pt lying in feces, the pt is sickle cell crisis, or the pt with "indigestion"?

    A rapid response called for indigestion was an incorrect rapid response. And leaving you hanging out to dry for indigestion is inexcusable! YOU CANNOT BE TWO PLACES AT ONCE! Period.

    The simple fact is a rapid response should require more that "chest pain". Was the EKG abnormal? Vital signs? Was the pt diaphoretic? Did the report "chest pain"? or something more vague? How long of a period transpired before initial report and assessment? WHAT WAS THE ASSESSMENT? One does not call a rapid response for indigestion, or chest pain, for that matter. You obtain EKG, blood work, contact MD, give NTG, and gather data. In absence of the time to gather all of the above data, you would only call a rapid response if the pt was deteriorating, and you did not know why. Indigestion does not equal deteriorating.

  • 1
    Anna Flaxis likes this.

    Quote from dudette10
    Yes. Twice in my short career my assessment findings reported to the MD have delayed or canceled discharge. I am responsible for confirming the stability of the patient at discharge, so yes, I do an assessment.

    you really should do the assessment. Earlier this month, I was engaging in the drudgery of getting VS on a discharged pt who was still there, b/c HE WAS STILL THERE, and it was assessment time.

    He was post op, and had temp of > 101.
    I reported it to the doc, and he and the other docs then had a discussion about whether to proceed w discharge. They felt it was likely post op atelectasis, but decided to keep him overnight, based on what one of the docs said "It's not worth it. CYA." It's the whole liability issue.

    So I CYA, and do the assessment. Always think about an attorney reading the chart, and having to defend what you did/did not do in court.

  • 0

    Know their mission statement.

    Be able to discuss your strengths and weaknesses. (this requires introspection, and you get points for thinking about and giving examples of how you have addressed, or intend to, address, weaknesses.)

    Be able to answer how you handled (or would handle) a difficult co-worker or angry patient, family member, or physician.

    Be able to answer the question "Why do you want to work here" (sounds like you have that one down cold, but be as specific as possible.)

    Smile, shake their hand warmly and firmly, take a deep breath, let your personality shine, and try to demonstrate your enthusiasm, and that you are a TEAM player.

    Dress tastefully and appropriately.

    Thank them for the opportunity to be interviewed.

    Good luck, and know that even if you don't get this position, it is a wonderful opportunity to gain interview skills.

  • 1
    lindarn likes this.

    I think the results of the poll are indicative of the following:

    The role of nurses as patient advocate. Period. I see that as my number one professional responsibility. We ARE the 24 hr link to the doctor! Pts and family members KNOW this, and I think these results reflect's because of all the wonderful nurses who say "I see your pain is not being managed, let me notify the doc and see what we can do." Or, "You are having a big surgery tomorrow, and will be on narcotics and mostly in bed for a few days. When was your last BM? 4 days ago? Okay, let's get you a laxative today. No need for minor constipation to turn into major discomfort!" Or taking the time and effort to simply make someone more comfortable, by performing thorough oral care on a pt. who is mouth breathing, dehydrated, and dying. By cheerleading! "Great job of ambulating and deep breathing, I know you are in pain, but this is going to speed your recovery!" By educating and comforting family members, telling them what to expect, seeking an early hospice referral, the list goes on and on.

    And this poll is very heartening! Despite the fact that we are often over-worked, the public clearly recognizes our role and it's importance in health care delivery.

  • 1
    lindarn likes this.

    Quote from kabfighter
    I find it interesting that psychiatrists get their own distinction from other medical doctors.
    I have an opinion about this gleaned from an unpleasant experience: Medical doctors are able to turn toward very rigorous, scientific, and objective evidence to support their diagnoses.

    Psychiatry, on the other hand, is stuck with FAR less objective data to support their's. It can take YEARS to get an accurate psychiatric diagnosis. Yet some are rendered upon first encounter. There are no lab tests to confirm their diagnoses. It is merely one person's OPINION, which may or may not be reached by another practitioner.

    Are you Borderline, or just way overstressed, with a sensitive, emotional bent? Are you truly a Narcissist, or do just have an overdeveloped ego and are a bit of a jackass? Do you actually have ADD, or are you unmotivated and/or depressed, or lazy, and that's just who you are?

    Labeling individuals is fraught w difficulty. Their main diagnostic tool is the MMPI, which is far from perfect, and does not render a picture of a holistic human being, and cannot be interpreted on face value. It only points one way, and cannot be interpreted out of the context of a person's life history.

    And therapy? I personally feel that those who are highly suggestible may attually be at risk when in therapy.

    We are all far more than the sum of our parts, or even our short term behaviors. Psychiatric pts. must be observed over time, and all behavior must be viewed in CONTEXT of circumstances and that pts particular history.

    All of these things make diagnosis and treatment difficult.

    Read the DSM, and see how many diagnoses you might see yourself fitting!

    The DSM and the MMPI really suck compared to cardiac enzymes and CT scans!

    I believe this is why pure medicine is a separate issue from psychiatry. Psychiatry is FAR from exact.

  • 4

    Quote from HM-8404
    Come back in 10 years? Lady I spent 12 years as a Navy Corpsman, the last 10 with the Marines. I was in the first Gulf War in 1990-1991, I served 3 tours in Iraq the second tour was with India Co. 2nd Mar. Div. in the 2004 battle for Fallugah, I also did 2 tours in Afghanistan where I was wounded and subsequently retired early due to injuries. The only reason I am in nursing school is because the nursing gurus do not accept any of my military training. It was either nursing or PA. Due to the loss of some fine motor skills in my hand there are some things I cannot do anymore so I chose nursing. I will guarantee you I could walk into any level 1 trauma ED and getting the same orientation as a new hire nurse nobody would know I never did an L&D clinical rotation.d

    I am stunned by your lack of compassion and superior attitude.

    Most people who suffer from addictions have painful personal histories. This, combined with a genetic vulnerability, pull the trigger.

    This is a cliche, but until you have walked in their shoes,or made some attempt to educate yourself about addiction, you really should hold your tongue.

  • 49
    ICUman, Kellorn, Bat Lady, and 46 others like this.

    Um, this article seems a bit over the top to me. Medical professionals are predatory, smell blood, etc.? I've been a nurse for over twenty years. That is way over the top.

    As many other posters have said, the way you precept, and your attitude, your leadership style may be a great match for some orientees.

    But not for me.

    I don't think anyone needs to be "broken down" in order to reach their full potential.

    And it's kind of condescending to think all new nurses need to be petted and coddled, and it is your job to toughen them up and show them how the real world is.

    I, and many others, were well equipped with enough innate intelligence that we already possessed some pretty good critical thinking skills before we ever even started nursing school, and also realize we have an intrinsic responsibility for our own professional growth and development.

    I look at new grads and nursing students as colleagues. I do not try to intimidate them. I get to know them as a person on some level; i.e., ask them when they are graduating, their future career goals, etc. I respect them, and they respect me. I freely tell them everything I know. I assure them there are no stupid questions. That knowing what one does not know is a cornerstone of safe practice.

    Positive, healthy interactions with all coworkers go a long way in making tough shifts bearable, even enjoyable.

    Support, teamwork, respect, sharing of knowledge, modeling leadership, and yes, KINDNESS. Despite whatever else is going on in my personal or work life.

    So I don't worry about my orientees speaking about their experience with me as a preceptor with other staff.

  • 3

    Dear Wish Me Luck,

    STOP! Don't do any such thing as surrender your license! You are clearly weary and depressed, and therefore not thinking with absolute clarity! I know, I've been there myself. Do not make such a big decision in this state.

    Trust me on this one: things have a way of working themselves out if you can put one foot in front of the other (baby steps) as previous poster stated, and go with the FLOW.

    The hardest battle is with YOURSELF, not the BON. Focus on the biggest battle, if you can win that one, all other issues will work themselves out. Without you surrendering your license.

    Love and best wishes,

  • 2
    GA_RN2006 and BabyRN2Be like this.

    I am reading a great book about addiction. It's called In the Realm of the Hungry Ghosts by Gabor Mate'.

    It is an extremely smart and compassionate book about addiction.

    Good luck on your journey, it sounds as if you are well on your way.

  • 4
    lindykid, brian, Joe V, and 1 other like this.

    I cannot tell you how much I enjoy this site.
    It provided me with a way to relate to colleagues as I was searching for a job after being out of the field for 12 yrs.

    I am back at work, and AN helped me tremendously as far as the current state of nursing, the interview process, etc.

    I have laughed and cried while reading posts.

    And I love the fact that I can post a question, and have expert responses within a few hrs. Thanks to all the nurses who post here!

    Thank you, and keep up the good work!

  • 1
    bg6RN likes this.

    Quote from LilgirlRN
    I feel your pain. I too am 52. Nurse for 25 years. ED is my specialty. I haven't worked as a nurse in 7 months but I have an interview tomorrow afternoon for an ED position. It really makes me wanna cringe. I got canned 7 months ago over something trivial, something that should have never cost me my job. I had some money saved so I thought I will take some time , do some soul searching and see what I really wanna do with my life. Only thing is my bills don't care if I feel lost in this new, stupid tedium of never ending patients seen in the ED for NUTHIN! Seriously I've seen people come by ambulance because they had a cold, told they have to wait, go out the front door, go across the street and call 911 again to be taken somewhere else. Our tax dollars at work! Not only do we have to care for the patient now we have to feed everyone, get them coffee, say the magic words "I'm here for you" when I'm really thinking get up and get out of here, I'm sicker than you are. Saw a thing on facebook recently, shows a man in a gown with his IV pole and a nurse standing beside him and the caption reads "I see you're here again for acute hypodilaudidism" Yep I'm burned slap up even after an almost 8 month hiatus but I gotta pay bills and have health insurance.
    When you're right, you're right!!!

    OMG, "hypodilaudidism"!

    I cannot tell you the ridiculous amts of narcotics I spend the great majority of my day pushing.TO PEOPLE WHO CLEARLY sDO NOT NEED IT. Once all the tests are run and the docs can find NOTHING wrong with them, theyare discharged. But this is after 3 or 4 days of IV pushes q 2 hr for mysterious pain, nausea, anxiety, and itching. And they frequently try to find reasons to leave the floor to...smoke!

    I just returned to nursing after a 12 yr hiatus, and this is one of the most disturbing things I've seen...the increase in drug seekers, and how they are catered to, and how they DEMAND to be to catered to.

    "Get up and get out of here, I'm sicker than you are". I HAD THAT SAME THOUGHT THIS WEEK, when I came to work after eating some spoiled dressing at a restaurant and vomited several times before my shift.

    I had a patient who claimed to be in 10/10 pain and nauseated, eating bar b que and recieving Dilaudid, ask me if she could leave the floor to smoke! I wanted to choke her! I WAS NAUSEATED! COULDN'T EVEN EAT LUNCH!

    I have seen a couple of these pts discharged with psychiatric consults.

    There has to be a better way. Narcotics are given way too freely and indiscriminately, and these pts know how to work the system. While our time is taken away from pts who need and deserve it.What a waste of resources.

  • 6

    I work on a very busy med-surg floor. Our ratio is 6:1. I punched out at 2040 tonight. And I know I have excellent time mgmt skills.

    The ratios are too high! They pile as much on us as they can get away with. We can't eat a 30 minute lunch without getting up to give a pain med or toilet someone (b/c the aid is busy), or receive a pt or send one to OR. While I make sure I get a 15 min brkst break, I NEVER take my other 15 minute break, which I am docked for. I think it is wrong and it is poor management to expect staff to work a 13 or 14 hr shift without their breaks.

    How can you take care of 6 high acuity pts safely? You can do it, but you are killing yourself. It leads to BURNOUT. And higher infection rates, higher complication rates, which leads to...higher mortality. And staff turnover.

    I had a pt in sickle cell crisis requiring q 2 hr pushes. Two fresh surgeries needing pain mgmt. Two units of blood to hang. Those pts got all my attention, while my others were pretty much ignored.

    Our ratios should be no more than 5:1. Preferably, 4:1.

    I am in a room trying to hang blood when I see that the IV is leaking, and must be restarted. While I have FOUR pts. calling for pain meds, and the OR wants to come get my other pt....

    No human can be three or four places at one time, yet...that is expected of us.

    IT SUCKS! What can we, as Professional Nurses, do?

    I am very worried about the future of nursing and healthcare. And I would never leave a loved one who was really ill alone on a Med Surg floor. B/c there is no guarantee they will be turned, or fed, or medicated as they SHOULD be. Or that their condition will be monitored as closely as it should.

    Not b/c the nurses don't WANT to, but b/c they just can't be two or three or four places at once.

    I don't see it changing. And that is why nurses leave the bedside. But I guess as long as their is an endless supply of new nurses willing to take it on, they will continue to demand this.

    Good for the bottom line, bad for pts. And bad for nursing.